Healthcare Provider Details

I. General information

NPI: 1477484673
Provider Name (Legal Business Name): DR. KATTYA IVETTE GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATTYA IVETTE GARCIA CARDONA

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 S BROADWAY
SANTA MARIA CA
93454-7813
US

IV. Provider business mailing address

6142 E PEABODY ST
LONG BEACH CA
90808-2823
US

V. Phone/Fax

Practice location:
  • Phone: 805-863-9430
  • Fax:
Mailing address:
  • Phone: 678-826-7976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number112980
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: